Why stigma exists

Firstly, there was a greater unwillingness to work with a PMI versus someone without a mental illness as they were considered incapable of carrying their own weight when it came to work. Secondly, PMI were also seen as burdensome to society in other ways such as requiring greater resources participants did not explicitly mention whether this refers to resources from family or from society in general such as money, time spent or effort being dedicated to them despite them not making any meaningful contribution to the society.

And also, the loss in terms of what they could actually contribute to the society. The repudiation towards mental illness being a legitimate medical condition appeared several times during the discussion where some participants subscribed to the weak-not-sick beliefs [ 39 ] about mental illness.

Some also expressed the opinion that PMI were just using mental illness as an excuse for their shortcomings or to circumvent their way out of their responsibilities. Prior research on prejudice has found that ethnic prejudice can be fostered due to upbringing [ 40 , 41 ]. Participants cited a lack of mental health literacy MHL on the part of the older generations as the reason for why this occurred.

Actually, I went through a supermarket, I think it was last weekend. Intergroup bias also surfaced as one of the reasons for stigma in the study, with PMI recognized as the out-group. Participants mentioned that stigma towards PMI may arise because of the general out-group discrimination towards people who are different. Further, participants also mentioned concerns about associative stigma which leads to an avoidance of PMI. The three sub-themes included a perceived lack of expertise to deal with PMI characterized by a feeling of a lack of adequate knowledge or understanding on how to interact with a PMI ,.

So like I might have to talk to…take care of them that kind of thing. Example will be I might come in for questioning, so I already have other things that I needed to do and not have any more extra problems added on. Although the attribution of mental illness to spiritual possession is not unique to Islam alone, our findings suggest that this belief was more prevalent among the Muslims in Singapore. At the same time, some participants remarked that the Islamic culture is more accepting towards mental illness and PMI, although the motivations behind such prosocial behavior was not elaborated.

Congruent to the existing literature that evinced the relationship between negative media portrayal of mental illness and stigma [ 42 , 43 ], our findings revealed that participants were exposed to stigmatizing portrayals of mental illness, where mental illness is associated with violence, which led to them endorsing beliefs that PMI are dangerous.

So, when I grew up, my impression is like when someone is depressed, confirm will turn violent. Several participants intimated that the stigma towards mental illness is harsher in Singapore compared to the Western world, stating that Asians are more conservative while Westerners are more liberal. For instance, one participant made a comparison of Asian culture with the United States where people are more open about mental illness.

You know, even normal people go to therapy. Maybe if we compare ourselves to like the Westerns, they are very outspoken like they talk about these kind of things. One participant also commented about how the Asian collectivist culture can contribute to in-out group stigma. It also has a very bad footing when it comes to someone who is outside that regular group. We have also included some comments made by participants, although not many, that are non-stigmatizing to provide a contrast.

Participants commented that PMI can be just like any other normal people, and be as productive as well. One participant even remarked that PMI can be the ones to be spreading positivity, a contrast from our third theme that PMI are contagiously negative. So they do more to make the people around them happy so they sort of feel happier themselves as well. Our findings unearthed the various determinants of stigma among the lay public in Singapore. In all, 11 themes were observed.

Drawing from Baral et al. The lowest level in the model represents the internalized beliefs that an individual has which incites stigmatizing attitudes towards PMI. The boundaries between the various levels in our model are porous such that determinants of stigma can have bi-directional influences. As one participant puts it, it is due to the upbringing which instills stigma that people are taught to perceive PMI as dangerous see quote in results section: 1.

Upbringing that instils stigma. Of course, it is also possible for stigma determinants to directly influence levels further than one level apart. There are several generic causes of mental illness stigma in our study which are similar to those reported in studies conducted in other countries.

For instance, the relationship between fear and social distance towards PMI has been documented by many studies [ 44 ]. Link et al. The notion that PMI are incompetent at work and burdensome is pervasive among the general public in Europe, as evinced by a review [ 47 ], and this surfaced in our findings as well. Hence, this suggests that there are some causes of mental illness stigma which are quite pervasive globally.

In contrast, the sub-theme perceived inability to handle interactions with PMI is more unique to our study. Our study also identified a few themes which shed light on how culture possibly influences stigma.

This possibly explains why earlier local studies found Chinese to have less social tolerance and more negative attitudes towards PMI as compared to other ethnicities [ 32 , 33 ]. This postulation is reinforced by the findings from the previous local nationwide study, which revealed that Chinese Singaporeans as compared to Singaporeans of other ethnicities, reported the highest social distance scores towards PMI [ 20 ].

The attribution of mental illness to spiritual possession, while not unique to Singapore is an important belief that can influence stigma. Studies have found that superstitious beliefs in mental illness being a result of spiritual possession can evoke feelings of apprehension towards PMI [ 51 ]. Further, this misconception may also lead to help-seeking from inappropriate sources, delaying the PMI from receiving formal psychiatric treatment [ 52 ].

The attribution of mental illness to spiritual possession is the most apparent among the Muslims participants. Despite the drawback of such a belief, participants acknowledged that Muslims are the most tolerant and accepting towards PMI, though they did not explicitly elaborate on the reason behind it.

Our finding on stigma being harsher in Asian as compared Western societies is corroborated by Shamblaw et al. Anecdotally, because of conservatism, Asians tend to avoid discussing subjects which make them uncomfortable, and mental illness happens to be one of such topics.

As such, mental illness becomes a highly shunned topic among Asians, resulting in a vicious cycle eventuating mental illness into a taboo among the Asian communities. The reluctance to talk about mental illness among Asians could be due also to the greater emphasis on moral attributions of mental illness. Krendly and Pescosolido's work on global differences in stigma reported higher stigma and greater emphasis on moral attributions in Eastern countries as compared to Western countries [ 55 ].

In an earlier study pertaining to the treatment gap in Singapore, Subramaniam et al. In Yang et al. As there is a strong emphasis on meritocracy in Singapore, stigma towards mental illness may arise due to the fact that many PMI have histories of disrupted academic or vocational careers, both of which happen to be highly valued in a meritocratic society. A plausible explanation for this is that because meritocratic worldviews are typically associated with the beliefs of a just world i.

The negative portrayal of PMI, such as attributing violence to mental illness in media reports [ 42 ] occurs in Singapore as well see results , although in reality, PMI are more likely to become a victim of violent crime than be the perpetrator [ 60 ]. Nonetheless, media can be a useful tool to reduce stigma if used strategically [ 61 ]. According to our findings, the taboo-ness associated with mental illness in Singapore is attributed to Asian conservative values.

Hence, the utilization of social media platforms to disseminate factual information about mental illness can potentially alleviate this taboo-ness, for it exposes youths to mental illnesses and potentially fosters more conversations about mental illnesses as well.

Another strategy to reduce stigma in Singapore would be to educate individuals about mental health issues from young, thus enabling them to understand these conditions without being clouded by prejudice. This may also potentially disabuse youths of the stigmatizing views which may have been imparted by the older generation. A possible approach would be to introduce MHL modules in the school curriculum, an approach that has been considered superior to other school-based interventions [ 63 ].

Importantly, these MHL modules should also enlighten students that mental illness is not due to a personal defect or spiritual possession, but is instead a legitimate medical condition. Our findings suggest that Singaporeans are likely to distance themselves from PMI due to several concerns, such as their perceived inability to handle the PMI or the perception that PMI are dangerous, and their unwillingness to work with PMI is due to the perception that PMI are burdensome.

Anti-stigma campaigns in Singapore should, therefore, consider incorporating social contact with PMI as a component. Creating opportunities for social contact with PMI may help allay some of the aforementioned misconceptions, as well as reduce some of the intergroup bias that lay public hold towards PMI. The effectiveness of diminishing prejudice through contact has been supported by a meta-analysis of over studies, which found that social contact can enhance knowledge regarding outgroup bias, increase empathy and perspective-taking [ 64 ].

A recent local study evaluated an intervention for college students comprising education and personal contact with a PMI with a diagnosis of depression. Such findings indicate that incorporating social contact in campaigns could be beneficial in assuaging the concerns of the lay public and thus reduce the unwillingness for social contact with PMI.

This is especially important given the finding from our study which suggests that Singaporeans tend to be condescending towards those who seemingly lack the potential to become successful. Thus success stories are important to change this mindset. However, while campaigns can create cognitive shifts, the effects may be ephemeral [ 64 ]. Ultimately, to better reduce stigma, there may be a need to also implement legislative changes that promote inclusivity of PMI in workplaces and schools.

There are some limitations in our study that need to be acknowledged. As this study pertains to the topic of mental health stigma, the responses by participants may be affected by social desirability bias especially given the FGD setting. This was mitigated by the neutral manner of tone and words which the facilitator adopted in conducting the discussion, and the assurance at the start of the FGD that there are no right or wrong answers to any questions.

Also, given the convenient sampling, there may be selection bias: participants who enrolled were individuals on two polarizing ends, namely those who have strong views against stigma towards mental illness and those with strong stigmatizing views towards people with mental illness.

Nonetheless, most of the reasons for stigma uncovered in this study largely concurred with those in existing literature, suggesting that selection bias was minimal. This study elucidated several determinants of stigma among the general public in Singapore using a qualitative approach.

A total of 11 themes emerged, and these were classified into a socioecological model to illustrate how stigma is influenced by culture and environment. Findings from this study suggest that certain factors which cause stigma are quite pervasive across different cultures, such as the fear towards PMI, and the perception that PMI are burdensome. The determinants of stigma that surfaced in our study which were unique were the elitist mindset among Singaporeans and the perceived inability to handle interactions with PMI.

Lastly, findings of this study, must be incorporated into future anti-stigma campaigns in Singapore to ensure cultural misgivings and beliefs are addressed adequately. Readers who wish to gain access to the data can write to the senior author MS mythily imh. Rehm J, Shield KD. Global burden of disease and the impact of mental and addictive disorders. Curr Psychiatry Rep. PubMed Google Scholar. Koen N, Stein DJ. Pharmacotherapy of anxiety disorders: a critical review. Dialogues Clin Neurosci.

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You can choose how much you reveal about your life. When people get to know someone with mental illness it helps reduce stigma. You may find it helpful to join a support group of one of the mental health organisations. It can be useful to meet others in the same situation, and support groups often have resources that may help educate family members and others about mental illness.

When negative stereotypes come up in conversation or in the media, you can actively dispel myths and educate people against harmful, inaccurate stereotyping. Be mindful about the words you use when describing yourself or others, avoiding insensitive and hurtful words, and words which define a person by their condition.

Speak up when you hear people make inappropriate comments about mental illness. People living with mental illness should be respected and accepted just like everyone else. People with mental health problems are entitled to the same rights and opportunities as everybody else. Challenge it if you see examples of discrimination or of bullying.

Discrimination in the workplace against someone with mental health issues is against the law in Australia under the Disability Discrimination Act. If you want to learn more about how to deal with stigma or report stigma, visit the SANE Australia website. For immediate counselling assistance, contact Lifeline on 13 11 Learn more here about the development and quality assurance of healthdirect content.

Read more on Better Health Channel website. Information on mental illness stigma. How it affects people living with mental illness and how you can reduce mental illness stigma.

Read more on Queensland Health website. Self-stigma reflects negative, culturally-generated stereotypes, beliefs and emotions about a specific feature shared by a group of people. Talking to children about mental wellbeing and health from a young age can help them understand their emotions, develop resilience and reduce stigma about mental illness. For many people, overcoming problems related to the social stigma of epilepsy is harder than living with the disease itself.

Read more on Epilepsy Action Australia website. Information and advice on talking to teenagers about your mental illness or mental health problem. About starting a conversation about mental illness with your child and family. Tips to think about and advice about how to approach the discussion. Do people ever recover from mental illness? There are a lot of opinions out there, but here, in one place, are the facts Advice and resources for family law practitioners when they work with families where a parent experiences a mental illness.

It is characterised by ongoing instability in the areas of interpersonal relationships, self-image and impulsivity. Read more on Ausmed Education website. Advice for emergency services police, fire and ambulance officers about how to help children when their parent is experiencing mental illness. Some simple gestures can make a huge difference to the child and their family. For example, one survey concluded that the majority of people in the U.

The respondents stated they do not support the idea of keeping those with a mental health condition out of society. The survey also suggests that generally, people do not believe that those living with mental illness are excessively dangerous or prone to violence. However, two-thirds of the survey respondents believed there was still a lot of stigma attached to mental illness, while almost half said they would not welcome a mental health facility into their neighborhood.

Keep reading to explore mental health stigma, its effects, and what people can do to overcome them. Stigmas in society are commonplace. They can be difficult to dismantle and overcome once they become established over many years. A stigma is a negative and often unfair social attitude attached to a person or group, often placing shame on them for a perceived deficiency or difference to their existence. Individuals or groups can apply stigma to those who live a certain way, have certain cultural beliefs or make lifestyle choices, or to people living with health conditions, such as mental illnesses.

Mental health stigma refers to societal disapproval, or when society places shame on people who live with a mental illness or seek help for emotional distress, such as anxiety, depression, bipolar disorder, or PTSD. The pressure of mental health stigma can come from family, friends, coworkers, and society on a broader level. Groups can also politicize stigma. It can prevent people living with mental illness from getting help, fitting into society, and leading happy and comfortable lives.

Mental health stigma can come from stereotypes , which are simplified or generalized beliefs or representations of entire groups of people that are often inaccurate, negative, and offensive. They allow a person to make quick judgments about others based on a few defining characteristics, which they then apply to anyone in that group.

For instance, people living with depression are often stereotyped as lazy, while some judge those with anxiety as cowardly. None of these characterizations are valid, and all of them are misinformed, cause pain, and prevent people from getting the help they need. An often politicized stereotype about people with mental illness is that they are violent or dangerous. However, a small minority of people living with mental illness commit violent acts.

They are actually 10 times more likely to be victims of a crime , making them a vulnerable population we should be protecting instead of fearing. Stigma against mental illness can come from several sources, such as personal, social, and family beliefs, and from the mental health condition itself, which may cause a person to act outside what is considered the social or cultural norm.

A lack of awareness, education, perception, and a fear of people with mental illness can all lead to increased stigma. According to the Mental Health Foundation, nearly 9 out of 10 people with a mental illness feel stigma and discrimination negatively impact their lives. They also state that those with a mental health issue are among the least likely of any group with a long-term health condition or disability to find work, be in long-term relationships, live in good housing, and be socially included in mainstream society.

Stigma against a person living with a mental health condition can make their symptoms worse and make it hard to recover.